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Tunbridge Wells Homeopathic Hospital to close

At a meeting of the West Kent PCT board, on 27 September 2007, it was decided
to withdraw all funding for homeopathy from the end of this financial year. This means the end for the Tunbridge Wells Homeopathic Hospital..

Congratulations to Dr James Thallon (Medical Director of the West Kent PCT) who done a good job for patients in his area by ensuring that NHS money is well spent. He appeared briefly on Channel 4 News to explain that if the cost of the Hospital were saved, a lot of patients would be able to benefit from the latest treatments.

The announcement of intention to withdraw NHS funding was followed by a public consultation. But the supporters of homeopathy could muster only 6273 votes and they were spread over four petitions (we shall never know how many people signed all four). A web site for the supporters of the homeopathic hospital has a movie of their town centre demonstration. The numbers there were less than overwhelming, though they were led by a rather fine piper.

At 08.30, the morning talk show on BBC Radio Kent that preceded the meeting had a discussion about the homeopathic hospital. If you can stand talk shows, listen here (a London homeopath, DC and Sally Penrose from British Homeopathic Association). The first speaker says “someone even called it crackpot medicine”. Ahem. Could that have been me?

Who owns the Homeopathic Hospital?

You might expect to be able to find out from NHS Choices, but that site is unhelpful (how does the Department of Health manage it?). Here is the information that I have.

The Tunbridge Wells Homeopathic Hospital building is owned by the Mental Health Trust. The building houses three services. (1) The homeopaths, who are owned by Maidstone Tunbridge Wells (MTW) Acute Trust, (2) a child and adolescent mental health service CAMHS, which is owned by the Mental Health Trust, and (3) Community Paediatrics which owned by W Kent PCT. It will be for MTW as provider to decide if they want to close the department in the light of the commissioning decision but if they did then the building itself would continue to house medical services though not the Department of Homeopathy.

The final outcome

“Of course homeopathy needs more research, but so do many areas of conventional medicine – without these NHS hospitals, this research won’t get done.”

The first part might be true, but the second is fantasy. The hospital did not produce a shred of good research. The report goes on.

“The PCT originally decided to withdraw funding for homeopathy – which costs the trust £200,000-a-year for 750 patients – last September, but the decision was challenged by patients through a judicial review which proved unsuccessful and led to the final decision being made last week.
Current patients will finish their treatment over the next eight months but the PCT will not pay for further routine homeopathic consultations or treatments after the end of March next year.”

haha, now you see, i know it makes me a total heretic, but i dont know how i feel about this.

being a dogged pragmatist, i think giving a harmless placebo to people who cannot be helped by medical drugs – but who demand the ritual of treatment – is fine, although someone ought to sit down and have a really hard think about the ethics of it.

i really think if homeopaths had thought that kind of thing through a little bit more carefully, instead of stomping about angrily telling everyone that MMR gives you Aids and pretending they can cure cancer with their magic beans, they might have been able to keep themselves afloat a bit better.

What was the Â£160,000 per annum actually spent on? Homeopathic medicine being basically water or sugar pills should cost practically nothing, so there should be nothing to stop any NHS doctor in any hospital offering it for free (almost), should he or she so wish. There was never any need for a homeopathy department, nor any need to spend any money on it.

I know exactly what Ben means. The homeopathic marchers look like a thoroughly nice and well-meaning bunch of people. Having put some effort into getting magical treatments out of the NHS, I now feel almost guilty when it happens. Who are we to destroy their fantasies?

On the other hand, it is just possible that lives could be saved if they now avoid bad advice about vaccination and serious diseases.

In any case, the real problem of the endarkenment lies not with a handful of homeopaths in Tunbridge Wells, but in government and universities. It is one thing for a lady of Tunbridge Wells to believe that the smaller the dose the bigger the effect. It is a much more serious matter when you get universities teaching such absurdities.

While Ben may be right to say that the biggest problem with homeopathy on the NHS is that they give wrong dangerous advice on serious conditions, there are several other problems.

One is that medicines have to (or ought to!) cross a cost-effectiveness threshold before being NHS fundable. The placebo effect of homeopathy is probably not sufficient alone to cross the threshold since it is -like other placebo effects – only really effective in minor, albeit, chronic conditions. A corollary – of opportunity cost – to that is that in a cash limited NHS where there is rationing, some effective (and more cost-effective) medicines are essentially cut to fund homeopthy. Is that fair or acceptable?

Secondly it is unfair to fund alternative treatments which are pure placebo when most research-based medicines has to show efficacy – and is measured on cost-effectiveness – beyond placebo as the key trials are judged against placebo or another treatment (with the placebo impact of each cancelling each other out).

Thirdly, the therapeutic effect of a purely placebo-based intervention like homeopathy is founded on the deception of the patient. Is this ethical? Alternatively, if a patient was told that homeopathy is mumbo-jumbo but works only because the patient thinks it will work, then it would lose efficacy and cost-effectiveness. Yes, other medicines (and docs) have powerful placebo effects but they do not rely on this.

Fourthly the homeopathy industry uses the fact that the “science/evidence-based NHS buys homeopathy” as their best defence in Parliament and policy debates, so all the above arguments are undermined by NHS homeopathy even if they did not talk rubbish about AIDS and MMR.

Finally, I do not want to have an NHS that spends my constituents tax dollars on this pseudo-science when we all rail against waste, and some of us want to see rational public policy.

pv – you can easily burn through Â£160 000 by employing a few full time staff and providing them with offices etc (count on overheads being 50%-100% of salery).

DC and Ben – as has been argued elsewhere, homeopathy wouldn’t be so bad if it limited itself to people with colds, fatigue and aches and pains. But if it did that it would have to admit that is has no real curative power at all (beyond the placebo). That wouldn’t be acceptable to most homeopaths.

More importantly, doing so would negate most of the placebo effect. People have to believe in magic for it to work.

CAM makes so much money that I would have thought Tunbridge could keep going easily by charging a minimal fee – see later.

If GPs want to “treat” (or pretend to treat) “patients with minor ailments with homeopathy as part of their normal consultation and “therapeutic encounter” process, then I won’t be starting a witch hunt to stop them. Whether they can hide this in their reimbursement set-up, who knows.

But – having “homeopathic hospitals”, and referring people to them with NHS funding, as if it was a proper evidence-based treatment – you’re having a laugh, for all the reasons Evan Harris lists above.

As I have said before on BadScience, my medical other half doesn’t go to great lengths talking people OUT of CAM interventions when (i) the patient is clearly determined; and (ii) there is no real therapy for them beyond the obvious (e.g. painkillers and keeping mobile for back pain) that they’ve already been told about ad nauseam.

Mrs Dr A’s compromise is to say “There’s no real evidence XYZ works” , and then if they are clearly determined (e.g. coming back and saying they want to try it) “Well, some people have said they thought it helped”…

…and then she tells them our local CAM-friendly Univ of Poppleford have a “walk in clinic” where you see a CAM “student practitioner” for a tenner.

This hopefully achieves the multiple objectives of

– patient gets a therapeutic encounter to hang their placebo on
– Mrs Dr A doesn’t have to lie to her patient
– the patient only gets relieved of a tenner
– the NHS doesn’t have to pay for a homeopath

I guess the guilt expressed above may be to do with that the wrong homeopaths are probably being hurt by this decision. Peter Fisher, for example, is the only homeopath I can think of that makes categorical statements about the limits of homeopathic treatment (malaria). The real menace comes not from medical homeopaths, but from lay homeopaths, represented by the Society of Homeopaths, who are often dangerously deluded and a threat to peoples’ well being.

The hospital must close because of the implicit support that NHS funding gives to the vast body of unregulated fantasy healers out there. Perhaps NHS homeopathy could have survived of more medical homeopaths took a far tougher stance on the dangerous nonsense dished out by their lay colleagues.

The only problem I see with letting patients with minor self-limiting (or non-existent) conditions go to CAM practitioners is that it leads to increased ignorance of the benefits and limits of proper medicine, and therefore more people – and hence more people going to doctors for the wrong reasons or with the wrong expectations, more disillusionment with proper medicine, and more support for unproven CAM. I am not a doctor, though, so I defer to the experience of those who are.

while i agree with almost everything that has been said here, i dont agree that homeopathy is necessarily wasteful when used cautiously in treatment resistant cases where patients demand “some kind of treatment”: in these circumstances medical treatments will only carry side effects without benefit, simply saying “there is no treatment” can be very difficult, and so on.

there are obviously ethical problems with this, both for homeopaths and the state, since it involves them lying to patients about efficacy. there are also other side effects from homeopathy, such as the problems of them being childish about pretending they can treat malaria and aids, the corrosive cultural effect of just accepting made-up health claims without restraint or limit, etc.

what i find fascinating is this:

i believe that if homeopaths had all sat down, and had a good hard think about this kind of thing, they could have found a way to practise thoughtfully and ethically, and addressed these side effects.

instead there is no evidence of any critical self appraisal whatsoever anywhere in their literature.

the top three papers in the bmj last year were highly critical of the practice of medicine.

i believe it was the complete and shameful absence of critical self appraisal from within that has led to homeopathy’s downfall, and although i think thats extremely interesting, you’re right, i’m not going to cry about it.

Downfall is probably too strong a word, these things have a habit of sticking around.

More importantly – can a practice thatâ€™s based upon a delusion (that the benefits of homeopathy are due to the ‘contents’ of the pills rather than a sophisticated placebo effect) really indulge in meaningful critical self appraisal?

To do so would require that they take things like evidence, bias and causality seriously. If they did they would inevitably conclude that itâ€™s all a sham (albeit a well meaning one that might make some people feel better).

It seems to me that it would be like asking a church to critically appraise the power of praying as a means of curing disease.

I suspect that if homeopaths did as you suggest the whole sandcastle of their belief would crumble pretty quickly. Instead, they indulge in all sorts of mental gymnastics trying to justify why clinical trials etc aren’t appropriate for homeopathy.

Feel free to slap me down if I’m being silly. Has anyone looked at the costs of a nice chat over a cup of tea with a sympathetic individual? It seems a large number of people turn to CAM when normal medicine has failed, a lot of homeopaths seem to be well meaning decent empathic people. Perhaps the NHS could employ them as a form of palliative care when all other options have failed. I don’t know how the costs would work out but there is a large community of CAM practitioners out there who genuinely want to help patients, but whose methods are dubious at best. If they could be trained to be a sympathetic ear and maybe use scented candles, massage, oils and the like but without the pseudoscience then it could be a useful resource.

It’s obviously a reasonable assumption that knowing something is a placebo probably negates its effects but has this ever been tested? Say by comparison of blue placebo pills with green or oral vs injected? Can’t be blinded, but that would be the point. You would explain to the participants that it’s a test of the placebo effect and see if the ritual does anything even if the patient knows it’s a placebo.

Ben, I see your point about homeopaths taking an inward look, realising that they may well be effective at reversing generalised symptoms via placebo administration, and carrying on in full awareness of this knowledge. However, i agree with woodchopper that if they really did this, their belief in a treatment regime that has no efficacy would dissolev, hence they don’t go there.

as for allocation of public funds to homeopathy, whether or not practitioners are prescribing tongue-in-cheek (which is pretty much what Ben’s suggesting) or with 100% confidence in some therapeutic mechanism (i.e. water memory etc), if there is no evidence for efficacy beyond placebo, you’re on a slippery slope towards provision of other CAM disciplines on the “but it makes me feel better somehow” basis.

gimpyblog, as for employing homeo-woos as counsellors, not sure that would work – without the remedies they truly believe work, how convincingly could they “act” as shrinks without slipping into pseudo-scientific gobbledygook?

Teek: that’s exactly the kind of discussion I would expect to see among CAM practitioners. Not only have they failed to have it themselves, they have angrily refused to print it when i have offered very politely to write it in their publications.

we can consider all of the problems with homeopathy as side effects, albeit more abstract ones than “tremor”, and like all side effects there may be a time when they are worth risking, so they need to be managed and they need to be given thoughtfully:

with CAM the big side effects are missed diagnoses, your brain falling out because you believe to much woo, dependence, encouragement of belief in the need for a biomedical cause and treatment for a problem when that may not be true, reinforcement of sick role, etc.

there are plenty of ways to address these problems. for example, CAM practices could be rigorously set up along more of a rehabilitation focused model, rather than “keep coming back”, but this is very rare because theyre private practitioners, one, but more importantly, theyre insightless so it doesnt occur to them, they just think theyre doing great stuff with the pills/laying-of-hands etc. they could address their number who offer bogus preventive measures for malaria, or cures for Aids (rather than actively endorsing them like the SoH!).

there are imaginable solutions. but the industry is completely resistant, because of structural problems. regulation will not solve this, and it seems to be deeply culturally embedded. what is most astonishing to me is that even when they have been brought into a university setting, CAM practitioners have somehow managed to wall themselves off from any kind of critical self appraisal, refusing to discuss even what they teach, how, the evidence, the questions in their exams, or even return phone calls.

they could be a valuable force in society, but instead, that kind of childishness will be the end of them.

Personally, I think that homeopathic hospitals are just fine — there’ll always be a market for woo so someone might as well make some cash off it (I also think that if they advise against proper medicine or actively advertise that homeopathy is more than a placebo then that’s fraud: I think they have a right to exploit an existing market but not to try to create one), and if a patient’s convinced they’re ill when they’re not then I don’t see the harm in a GP suggesting they try altmed; it might be just what they need. But publicly funding woo is wrong.

In order for it to be effective, the NHS has to pretend homeopathy does something, which is literally lying to the general public. (I love how things suddenly become very black-and-white when it’s public money being spent.) And while a friend offering altmed treatment for free would have a little moral dilemma on his hands, a public body really doesn’t: you just can’t spend public money on deceiving the public. I think all publicly-funded enterprise should be as transparent and honest as is practicable.

If we’re happy for the NHS to lie to the public in what they consider to be our best interests, why should we complain when ministers do it?

with CAM the big side effects are missed diagnoses, your brain falling out because you believe to much woo, dependence, encouragement of belief in the need for a biomedical cause and treatment for a problem when that may not be true, reinforcement of sick role, etc.

I find talking about ‘CAM’ in this way problematic. The side effects you list are correct re. homoeopathy; however, other types of CAM can have much more serious side effects. E.g. CAM approaches like chelation, colloidal silver, colonic irrigation, etc. can cause a range of different side effects that wouldn’t happen with homoeopathy.

Sorry to keep going on, but I have a reputation as a pedant to keep up.

Homeopaths are never going to engage in a serious discussion about when it should and should not be used because homeopathy is a panacea.

Homeopaths claim to be able to treat every condition under the sun (and some that aren’t). They also claim to ‘treat the person rather than the disease’ and thereby ignore what is specifically wrong with someone.

Panaceas are very attractive to a certain mindset that likes easy answers. But they are an analytical dead end. I really donâ€™t think its possible for people who believe in them to have a serious discussion on when they should not be used, or to engage with people (particularly in universities) who care about specificity.

Well the pics on the protesters’ website were distinctly underwhelming. Hardly rent-a-mob. Apart from being wrong about the science and the medicine, they could not muster significant support, so I am cheered by the apparent good sense of most of the general public.

I don’t agree with some posters here that homeopathy has ANY place in health care. It doesn’t, because of the lying dilemma that David expounds so well. We have to find other ways of dealing with the worried well that are ethical.

One of the differences between ‘conventional’ medicine and CAM seems to be that you can categorically state to your patients in CAM that your treatment _will_ help them. This is something you just cannot do in conventional medicine because it would be misleading the patient. CAM practitioners I have seen, even Fisher, are able to assure the patient that they will be helped by these treatments. You may take the view of Ben that this is fine, but if a substantial part of the benefit of NHS delivered CAM is through lying to the patient, might it not be cheaper just allowing existing medical practitioners to lie to chronic patients.

I’ve heard of patients being taken by NHS transport across southern England twice a week to receive their ‘cost effective’ NHS placebo. If we are going to start explicitly using placebo I’m sure there must be a cheaper way of doing it!

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